Omni Dermatology Olive LLC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

OMNI DERMATOLOGY OLIVE LLC

Practice address

5700 W Olive Ave
Ste 101
Glendale, AZ 85302-3147

Phone

(602) 559-5470

Fax

(602) 559-5471

NPI assigned

Nov 15, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Andrew Joseph Racette, D.O.NPI 1447429097

Title

President

Phone

(602) 954-3919

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Andrew Joseph Racette, D.O.

  • Dermatology Physician
  • Phoenix, AZ
  • NPI 1447429097
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1479168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479168000000",
    "number": "1669914172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4840 E INDIAN SCHOOL RD",
            "address_2": "STE 102",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850185500",
            "telephone_number": "602-954-3919",
            "fax_number": "602-954-3670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5700 W OLIVE AVE",
            "address_2": "STE 101",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853023147",
            "telephone_number": "602-559-5470",
            "fax_number": "602-559-5471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OMNI DERMATOLOGY OLIVE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-15",
        "last_updated": "2016-11-15",
        "status": "A",
        "authorized_official_last_name": "RACETTE",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "602-954-3919",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dale Albert Olson, COTA/L
• Mary Olson, PHARMD
• Olympic Ptwest at Arrowhead LLC
• Elsadig Mahmoud Omer
• Omni Dermatology Incorporated
• Oluwatoyosi Dada Omojaro, M.D.
• Victoria Omutsani, PHARMD
• On Call Dental LLC
• On Point Podiatry PLLC
• Wendy Achieng Ondiek, PHARMD

• Specialist in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Specialist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.